Department of Neurological Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
Department of Neurological Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
BMJ Case Rep. 2020 Dec 17;13(12):e236550. doi: 10.1136/bcr-2020-236550.
Optic pathway cavernous malformations represent less than 1% of all central nervous system cavernomas. They can lead to visual loss with indeterminate speed, and therefore, the timing of intervention is controversial. We present a patient with an optic nerve cavernoma, which was discovered incidentally 3 years before the onset of visual symptoms. The evolution of her symptoms, visual function and radiographic findings are reported in detail. The cavernoma was eventually removed via a transciliary orbitocranial keyhole approach with the goal to protect the optic chiasm from progressive involvement. The function in the affected optic nerve was not salvageable. This is the second reported case of a cavernoma selectively involving the intracranial portion of the optic nerve. The debate on the timing of intervention is highlighted with reference to the natural history of these rare lesions.
视神经海绵状血管畸形占中枢神经系统海绵状血管畸形的比例不足 1%。它们可能导致视力逐渐丧失，因此介入治疗的时机存在争议。我们报告了 1 例视神经海绵状血管畸形患者，其在出现视觉症状前 3 年偶然被发现。详细报告了她的症状、视力和影像学表现的演变过程。海绵状血管畸形最终通过经眶颅眶锁孔入路切除，目的是保护视交叉免受逐渐累及。受累视神经的功能无法恢复。这是第二例选择性累及视神经颅内段的海绵状血管畸形。参考这些罕见病变的自然病史，强调了介入治疗时机的争议。
